B-2018-0966 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0966
10745 N DE ANZA BLVD UNIT 124 CUPERTINO,CA 95014(326 26 046) WATER HEATERS
ONLY INC
GRASS VALLEY,CA
95945
OWNER'S NAME: DATE ISSUED:06/06/2018
OWNER'S PHONE: PHONE NO:(800)835-8345
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#374573 -
Contractor WATER HEATERS ONLY INC Date 0 5131/2 01 9 X BLDG_ELECT X PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
(N)50 GAL WATER HEATER-INSIDE CLOSET
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$3868.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
.Information Is correct.I agree to comply with all city and county ordinances APN Number; Occupancy Type:
and state laws relating to building.construction,and hereby authorize 326 26 046
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save Indemnify and keep harmless the
City of Cupertino against liabilities,Judgments,costs,and expenses which PERMIT EXPIRES IF WORK 1S NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature /" Data 06/06/2D18 Issued by:Jasmine Archbold
Date:06/06/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If e roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agreeto remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Cade). Date:06/06/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOT COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performsnce,of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain comptiance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this portrait is issued,! Health&Safety Code,Section 25532(.)should 1 store or handle haz.rdans
shall net employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certificate or will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized
APPLICANT CERTIFICATION Date:06/06/2018
I certify that have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes, (We)agree Lender's Name
to save Indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City In Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT BECI ARATION
Code,Section 9.18. understand my plans shall be used as public records.
SignatureLicensed
Data 06/0612018
Professional